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Dr. John Wade

MD, FRCPC

Rheumatologist

Vancouver, BC

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La polyarthrite rhumatoïde Traitement

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Diagnosis and Treatment of Gout " George is a 46-year-old plumber with pain and swelling in his big toe"

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Dr. John Wade

, Rheumatologist, at Vancouver Coastal Health in Vancouver, BC commented on: Rheumatoid Arthritis in a Patient with Knee and Wrist Swelling " Larry a 58-year-old gentleman".

The most common joints affected by septic arthritis are the knee, hip, shoulder, elbow, wrist, and finger. Most often, only one joint is affected. Symptoms can occur a bit differently in each person, but common symptoms include:\nFever\nJoint pain\nJoint swelling\nThe symptoms of septic arthritis can look like other health conditions. Make sure you see your healthcare provider for a diagnosis.

See the whole conversation: Rheumatoid Arthritis in a Patient with Knee and Wrist Swelling " Larry a 58-year-old gentleman"

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Dr. John Wade

, Rheumatologist, at Vancouver Coastal Health in Vancouver, BC commented on: Arthritis and Back Pain - Ankylosing Spondylitis " Randy a 26-year-old college graduate ".

Ankylosing Spondylitis is a long term disease that typically effects young men in the spines. The disease causes back inflammation and stiffness, as well with regions of the spine to fuse together. If you are interested in treatment for your Ankylosing Spondylitis, seeing your Family Physician could help, as they may refer you to a Rheumatologist.

See the whole conversation: Arthritis and Back Pain - Ankylosing Spondylitis " Randy a 26-year-old college graduate "

Dr. Graham Wong

MD, MPH, FRCPC, FACC, Acute Cardiac Care, VGH

Cardiologist

Vancouver, BC

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What is an Echocardiogram?

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How a Pacemaker Treats an Irregular Heartbeat " Shirley a 75-year-old previously healthy woman"

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Dr. Graham Wong

, Cardiologist, at Vancouver Coastal Health in Vancouver, BC commented on: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain".

A Comprehensive Guide on Heart Failure Congestive heart failure (often called heart failure) is a chronic heart condition that occurs when your heart muscle is ineffective at pumping blood. As a result, your body hangs on to salt and water, causing your heart to beat faster and potentially get bigger. Heart failure may be a chronic condition (ongoing) or acute (occur suddenly). Certain conditions such as high blood pressure, diabetes and coronary artery disease can lead to congestive heart failure. There are a number of treatments for heart failure, and lifestyle changes can help improve your quality of life. Causes of Heart Failure There are a number of conditions that can lead to heart failure; it is most often related to another disease or illness such as: Coronary artery disease. This is the most common cause of heart failure. A previous heart attack resulting from coronary artery disease. High blood pressure. If your heart has to work harder to circulate blood throughout your body, it can make your heart muscle weak or stiff. Diabetes. There is a link between diabetes and heart failure. Cardiomyopathy. Diseases, infections or abuse of alcohol/drugs can cause this condition. Lifestyle factors can increase your risk of heart failure, including smoking, excessive alcohol use and physical inactivity. Type of Heart Failure There are four types of heart failure: Left-sided heart failure, which causes fluid to back up in the lungs. Right-sided heart failure, which causes fluid to back up into your abdomen, feet and legs. Systolic heart failure, which is a pumping problem in the left ventricle. Diastolic heart failure, which is a filling problem in the left ventricle. Symptoms of Heart Failure It’s important to see your healthcare provider for regular checkups, and especially if you're experiencing symptoms of heart failure, which can include: Shortness of breath, especially when you exercise or lie down Chest pain Fatigue Nausea Irregular or rapid heartbeat Weakness Edema (swelling) in your feet, ankles, legs or abdomen Wheezing or cough Lack of appetite Difficulty concentrating Pink-tinged mucus or phlegm Risk Factors for Heart Failure There are many different risk factors for heart failure, including: Coronary artery disease High blood pressure Diabetes and some diabetes medications Heart attack Obesity Viruses Sleep apnea Certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) Alcohol or drug use Congenital heart defects Smoking There are also complications that can occur as a result of heart failure, including: Heart valve or heart rhythm problems Liver damage from a buildup of fluid that puts pressure on the liver and causes scarring Kidney damage, due to reduced blood flow to the kidneys How to Prevent Heart Failure The best way to prevent heart failure is to make healthy lifestyle changes. This reduces your risk factors. In addition, see your physician regularly and take all medications as prescribed. Some of the lifestyle changes that can prevent heart failure include: Quitting smoking Abstaining from alcohol or limiting your intake Eating a healthy low-fat, low-sodium diet Maintaining a healthy weight Getting regular exercise Effectively managing other conditions such as coronary artery disease and high blood pressure Diagnosing Heart Failure To diagnose heart failure, your physician will perform a physical exam to look for things like congested lungs or fluid buildup. He or she will review your medical history and you’ll have a chance to discuss your symptoms. If your physician thinks you should undergo further testing, he or she may order: Blood tests. This may show conditions that can affect the heart and a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP). X-rays. An X-ray image of your chest can show the condition of your heart and lungs. Echocardiogram. This test produces a video image of your heart, which can show abnormalities and measure how well your heart is pumping. Electrocardiogram (ECG or EKG). Your doctor will attach electrodes to your skin to record the electrical activity of your heart. Cardiac computerized tomography (CT) scan. This machine collects images of your chest and heart while you lie on a table. Magnetic resonance imaging (MRI). This machine produces a magnetic field to create images of your heart. Coronary angiogram. The doctor will insert a thin catheter into a blood vessel (groin or arm), and then guide it into your coronary arteries. Dye is injected into the catheter so that your physician can visualize blockages. Stress tests. Usually, you’ll walk on a treadmill while attached to an ECG machine to measure the effects of exertion on your heart. Treatment of Heart Failure Treatment of your heart failure depends on the type and severity. It’s important to remember that there is no cure for heart failure, but treatment can improve your symptoms and strengthen your heart. There are three main types of treatment for heart failure: medications, devices and surgery. Generally, physicians will prescribe a combination of medications to treat your condition, including: ACE (angiotensin-converting enzyme) inhibitors. These drugs are a type of vasodilator, which lower blood pressure and improve blood flow. By widening the blood vessels, ACE inhibitors help you feel better, as there is less stress on the heart. Aldosterone antagonists. Also known as potassium-sparing diuretics, these are often prescribed for patients with severe heart failure symptoms. Angiotensin II receptor blockers. These drugs are often used as an alternative for patients who can’t tolerate ACE inhibitors; they have many of the same benefits. Beta blockers. Another common medication for heart failure, beta blockers reduce blood pressure and slow your heart rate; they may even reverse some heart damage. Digoxin. Also known as digitalis, this medication is used to slow the heartbeat and increase reduce heart failure symptoms. Diuretics (water pills). These are prescribed to prevent you from retaining fluid, which can reduce edema. You’ll probably have to take potassium and magnesium supplements if you take diuretics. Nitrates. These can help reduce chest pain. Statins. You may take statins to lower cholesterol. Some of the devices used to treat heart failure include: Biventricular pacing (also known as cardiac resynchronization therapy). This type of pacemaker sends timed electrical impulses to the heart, improving pumping. This treatment may be combined with an ICD. ICDs (implantable cardioverter-defibrillators). Similar to a pacemaker, an ICD is implanted in your chest, and its wires lead through your veins and into your heart. If your heart stops or begins beating too irregularly, the ICD will get it back into a normal rhythm. Oxygen tanks. Patients with severe heart failure may need to use supplemental oxygen on a regular, long-term basis. VADs (ventricular assist devices). A mechanical pump is implanted into your chest or abdomen to help pump blood from your heart to the rest of your body. These may be used in patients waiting for a heart transplant. If you need surgery to treat heart failure, you may undergo: Coronary bypass surgery. The cardiothoracic surgeon will take blood vessels from your leg, arm or chest to bypass a blocked artery in your heart. Following coronary bypass surgery, blood should flow more freely through your heart. Heart valve repair (or replacement). If you have a faulty heart valve, you may need heart valve repair; if it’s more severe, you may require valve replacement surgery. Heart transplant. If medications, devices or surgery doesn’t help, you may need to have a heart transplant. When Should I Call a Doctor? Heart failure can be life-threatening, so call 911 if you experience any of these signs or symptoms. Too many patients question symptoms or wait to seek emergency treatment, which can lead to further heart damage. Chest pain or tightness in your chest Fainting Severe shortness of breath that comes on suddenly Coughing up pink, foamy mucus Severe weakness If you experience other symptoms of heart failure, such as edema or lack of appetite, contact your doctor or cardiologist. With early diagnosis and treatment for congestive heart failure, it’s possible to live a long, healthy and active life. Talk to your physician about heart failure causes, symptoms, risk factors and treatments. Find more heart health resources at HealthChoicesFirst.com.

See the whole conversation: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"

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Dr. Graham Wong

, Cardiologist, at Vancouver Coastal Health in Vancouver, BC commented on: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol ".

A cardiac stent is a small, expandable metal or plastic tube that is inserted into a narrowed artery to keep it open. It can also be called a heart stent or coronary stent. To open larger arteries, your surgeon may use a stent graft made of fabric. Usually these blood vessel blockages are caused by a buildup of plaque. You may need an emergency stent if your coronary artery is blocked and/or you suffer a heart attack. The surgeon will place a catheter into the blocked coronary artery, followed by a balloon angioplasty and a stent in the artery. A stent procedure is much less invasive than coronary artery bypass surgery. Generally, recovery after a stent surgery results in less discomfort and a shorter recovery time. Your doctor will usually recommend blood-thinning drugs such as aspirin to prevent blood clots. Before getting a stent, your doctor will tell you not to take any drugs that will make it harder for your blood to clot. During the cardiac stent procedure, the surgeon will make a small incision - usually in the groin or arm - and use a catheter to guide surgical tools through your blood vessels. He or she may use an angiogram to help guide the stent to the broken or blocked blood vessel. Once the stent is placed, the surgeon will close the incision. Most patients remain in the hospital overnight after a heart stent surgery. Many patients are able to return to work after a week, however, often those who have undergone emergency stent surgery take longer to recover. Your physician will recommend no heavy lifting or strenuous activity for a few weeks after surgery.

See the whole conversation: Increasing Chest Pain and Cardiac Stents " Wayne a 52-year-old man with high cholesterol "

Dr. Amin Javer

MD, FRCFC, FARS

Otolaryngologist

Vancouver, BC

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What is Acute Sinusitis?

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How is Chronic Sinusitis Diagnosed and Treated? - " Bill a 50-year-old male"

Dr. Bassam Masri

MD, FRCSC

Orthopaedic Surgeon

Vancouver, BC

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Hip Pain Caused by Osteoarthritis

Dr. Jan Dutz

MD, FRCPC

Rheumatologist

Vancouver, BC

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Treating Atopic Dermatitis

Dr. David Maberley

MD, FRCS(C), MSc

Ophthalmologist

Ottawa, ON

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Détection et prévention de la rétinopathie diabétique

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What is Diabetic Retinopathy of the Eye? " John a 55-year-old male who has had type 2 diabetes "

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Dr. David Maberley

, Ophthalmologist, at Vancouver Coastal Health in Ottawa, ON commented on: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye ".

A swelling in the macula, an area near the centre of the retina, the part of the eye that is responsible for fine or reading vision. People with diabetes are at higher risk of macular edema.

See the whole conversation: Age-Related Macular Degeneration? " Betty a 75-year-old female with sudden onset of central vision loss in her right eye "

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Dr. David Maberley

, Ophthalmologist, at Vancouver Coastal Health in Ottawa, ON commented on: Diabetic Retinopathy and Sudden Changes in Vision " Jim is a 31-year-old accountant who feels his vision has recently worsened".

A disease in which the small blood vessels (capillaries) in the back of the eye (retina) bleed or form new vessels. This condition usually occurs in people with long-standing diabetes. Regular eye examinations are an important part of diabetes management.

See the whole conversation: Diabetic Retinopathy and Sudden Changes in Vision " Jim is a 31-year-old accountant who feels his vision has recently worsened"